Factors Affecting Tooth Preparation General Factors Diagnosis. Generally, the objectives of tooth preparation are to (1) remove all defects and provide necessary protection to the pulp, (2) extend the restoration as conservatively as possible, (3) form the tooth preparation so that under the forces of mastication, the tooth or the restoration (or both) will not fracture and the restoration will not be displaced, and (4) allow for the esthetic and functional placement of a restorative material. The unpredictable development of this pain may undermine patients’ confidence in the clinician and acceptance of the procedure. factors of natural teeth affecting tooth preparation when preparing natural tooth for crown several different factors must be taken into account before the Enameloplasty is the removal of a shallow developmental fissure or pit in enamel to create a smooth, saucer-shaped surface that is self-cleansing or easily cleaned. In cavitated caries, the enamel surface is broken (not intact), and usually the lesion has advanced into dentin. The etiology, morphology, control, and prevention of caries are presented in Chapter 2. Additional oral conditions (discussed in Chapter 2) conducive to caries development also must be present and often are prevalent in older patients. The axial wall is the internal wall parallel to the long axis of the tooth. Steps Of Cavity Preparation 1. Restorations also are indicated to restore proper form and function to fractured teeth. present and often are prevalent in older patients. If it is bonded to enamel, it needs to be 1.0 mm. A tooth preparation is termed simple if only one tooth surface is involved, compound if two surfaces are involved, and complex if a preparation involves three or more surfaces. Several disadvantages have been observed for the conventional technique. As you can see, numerous factors influence preparation design. An assessment of pulpal and periodontal status influences the potential treatment of the tooth. EHS-Net Recommends. hand instruments for cutting. Table 5-1 compares factors related to restorative choices when choosing between amalgam and composite materials. When such areas are exposed to oral conditions conducive to demineralization, caries may develop (. Search. If the treatment involves multiple teeth, the preparation design is altered to increase the predictability of restoration fabrication. Modern porcelains are far more able to closely replicate natural teeth, with all-ceramic restorations mimicking the translucency and opalescence found in dental enamel. Three morphologic types of primary caries are evident in clinical observation: (1) lesions originating in enamel pits and fissures, (2) lesions originating on enamel smooth surfaces, or (3) lesions originating on root surfaces. Avoiding tooth loss may be partly within your control, research suggests. Much of the scientific foundation of tooth preparation techniques was presented by Black. Prophylactic odontotomy is presented only as a historical concept.10 The procedure involves minimal preparation and amalgam filling of the developmental, structural imperfections of enamel, such as pits and fissures, to prevent caries originating in these sites. This principle for the removal of dentinal caries is supported by the observation by Fusayama et al. Restorations also are required for teeth simply as part of fulfilling other restorative needs. Toothbrush abrasion is the most common example and is usually seen as a sharp, V-shaped notch in the gingival portion of the facial aspect of a tooth. Materials and methods More conservative, less expensive definitive restorative procedures may be indicated until the patient develops oral conditions consistent with low caries risk. Caries is episodic, with alternating phases of demineralization and remineralization, and these processes may occur simultaneously in the same lesion. An arrested, dentinal lesion typically is “open” (allowing debridement from toothbrushing), dark, and hard, and this dentin is termed sclerotic or eburnated dentin. STEPS OF CAVITY PREPARATION MADE BY: ABHINAV FINAL YEAR 2010-2011 2. Older adults who have physical or medical complications may require special positioning for restorative treatment and shorter, less stressful appointments. Root caries is becoming more prevalent because a greater number of older individuals are retaining more of their teeth and experiencing gingival recession, both of which increase the likelihood of root caries development. Usually, these areas are not susceptible to caries because they are cleansed by the rubbing of food during mastication. Usually, pain is not associated with this condition, unless the gingival, Simple, Compound, and Complex Tooth Preparations, Abbreviated Descriptions of Tooth Preparations. The patient’s esthetic concerns, economic status, medical condition, and age should be taken into consideration when selecting the various restorative materials to be used in a given procedure. These features allow a reduction in the complexity of the tooth preparation. When all-ceramic translucent materials are used to fabricate the restoration, it is possible to use a more conservative preparation. The cavosurface angle is the angle of tooth structure formed by the junction of a prepared wall and the external surface of the tooth. These teeth have lots of grooves, pits and crannies, and multiple roots that can collect food particles. It has been proposed that the predominant causative factor of some cervical, wedge-shaped defects is a strong eccentric occlusal force (frequently manifested as an associated wear facet) resulting in microfractures or abfractures. This chapter emphasizes procedural organization for tooth preparation and associated nomenclature, including the historical classification of caries lesions. 5-5). Fractures are among the more difficult and challenging defects of teeth, in both diagnosis and treatment. Attrition is the mechanical wear of the incisal or occlusal surface as a result of functional or parafunctional movements of the mandible (tooth-to-tooth contacts). If the dentist and technician are truly engaged in a collaborative relationship, these discussions should be occurring pre-treatment, not after the technician receives the case. Because the discoloration is slight in acute caries, and the bacterial front is well behind the discoloration front, some discolored dentin may be left, although any “clinically remarkable” discoloration should be removed.12. 5-8 and 5-9). This lateral and pulpal progression results in unsupported enamel. Careful diagnosis and development of a comprehensive treatment plan must be accomplished before the restoration of individual teeth is pursued to ensure appropriate restorative intervention. Prophylactic odontotomy is no longer advocated as a preventive measure. In amelogenesis imperfecta the enamel is defective in form or calcification as a result of heredity and has an appearance ranging from essentially normal to extremely unsightly.15. Such microfractures occur as the cervical area of the tooth flexes under such loads. Describe the characteristics of x-radiation. Complete coalescence of the enamel developmental lobes results in enamel surface areas termed grooves and fossae. The slow rate results from periods when demineralized tooth structure is almost remineralized (the disease is episodic over time because of changes in the oral environment). Erosion is the wear or loss of tooth surface by chemico-mechanical action. Knowledge of Dental Anatomy: knowledge of the external and internal structures of the tooth, and the relationship with surrounding tissues. Decay most often occurs in your back teeth (molars and premolars). The predictability of the clinical insertion process is dependent on how the case was designed and the tooth/teeth prepared, considering all the influencing factors. Much of the scientific foundation of tooth preparation techniques was presented by Black.1 Modifications of Black’s principles of tooth preparation have resulted from the influence of Bronner, Markley, J. Sturdevant, Sockwell, and C. Sturdevant; from improvements in restorative materials, instruments, and techniques; and from the increased knowledge and application of preventive measures for caries.2–6. For example, the maxillary four anterior teeth are to be restored for esthetic and structural reasons. Non-hereditary enamel hypoplasia occurs when ameloblasts are injured during enamel formation, resulting in defective enamel (diminished form, calcification, or both). When the spread of caries along the DEJ exceeds the caries in the contiguous enamel, caries extends into this enamel from the junction and is termed backward caries (Fig. Restorative treatment (sometimes along with periodontal treatment) is indicated. The slow rate results from periods when demineralized tooth structure is almost remineralized (the disease is episodic over time because of changes in the oral environment). 5-8 and 5-9). Backward caries extends from the dentinoenamel junction (DEJ) into enamel. Margins should be paced in easily cleansable areas. Visualization of the cavosurface angle and the associated minimal restorative material angle for a typical amalgam tooth preparation. The point angle is the junction of three planal surfaces of different orientation (see Figs. The enamel disintegration in smooth-surface caries also may be pictured as a cone, but with its base on the enamel surface and the apex at, or directed toward, the DEJ. Infected dentin has bacteria present, and collagen is irreversibly denatured. 5-1, A).8. A careful examination must be performed to determine an accurate diagnosis and to render subsequent appropriate treatment. Fracture involving vital pulp always results in pulpal infection and severe pain. may develop in a groove or fossa, however, in areas of no masticatory action in neglected mouths. Although the junction of two or more prepared surfaces is referred to as angle, the junction is almost always “softened” so as to present a slightly rounded configuration. When replacing a missing tooth with a fixed or removable partial denture, the teeth adjacent to the space may require some type of restorative procedure to allow for optimal placement and function of the prosthesis. Patient factors play an important role in determining the appropriate restorative treatment rendered. If a single tooth will be restored, that particular tooth dictates the determining factors in the preparation design. This defect is termed, Incomplete Fracture Not Directly Involving Vital Pulp, Complete Fracture Not Involving Vital Pulp, This represents complete separation of a fragment of the tooth structure in such a way that the pulp is not involved. This allows for a predictable path of insertion, easy cleanup of cement, and margin locations that meet the required morphology changes. The condition may be found in only a few locations in a mouth, and the lesion is discolored and fairly hard. PREPARATION OF THE CANAL SPACE AND TOOTH Several methods of preparing the post space … This represents complete separation of a fragment of the tooth structure in such a way that the pulp is not involved. Dental caries is an infectious disease, and prevention often requires prophylactic restorative procedures (see, Proper tooth preparation is accomplished through systematic procedures based on specific physical and mechanical principles. The predictability of the restoration fabrication process can influence the preparation design and the case outcome. It may be acceptable, however, when it exists as affected dentin, especially near the pulp (see the section Affected and Infected Dentin). Black noted that in tooth preparations for smooth-surface caries, the restoration should be extended to areas that are normally self-cleansing to prevent recurrence of caries.1 This principle was known as extension for prevention and was broadened to include the extension necessary to remove remaining enamel defects such as pits and fissures. When less tooth structure is removed, the potential for damage to the pulp is lower. The slow rate of caries allows time for extrinsic pigmentation. Acute caries, often termed rampant caries, refers to disease that rapidly damages the tooth. Extend the cavity margin until sound tooth structures obtained and no unsupported enamel remains. An assessment of pulpal and periodontal status influences the potential treatment of the tooth. Can the technician manage the masking of the discolored teeth, and with what materials? Factors Affecting Tooth Preparation 1. Such a wall takes the name of the tooth surface (or aspect) that the wall is adjacent to. This defect is termed idiopathic erosion or abfraction.14. It is often termed, Chronic caries is slow, or it may be arrested after several active phases. Patients at high risk for dental caries may require an initial treatment plan designed to limit disease progression (i.e., control caries) until caries risk factors are reduced or eliminated. The factors that determine outline form are the following: Extent of the carious lesion. When discussing or writing a term denoting a combination of two or more surfaces, the –al ending of the prefix word is changed to an –o. Care must be taken to consider all aspects of the case before tooth preparation begins, no matter the number of teeth that will be prepared. Restoration of Compromised Teeth Optimal restorative management of the compromised tooth can only be achieved by making a systematic and thorough assessment of the tooth, within the context of the dentition, the supporting structures and the patient as a whole. An incomplete fracture not directly involving vital pulp is often termed a “greenstick” fracture. Teeth need restorative intervention for various reasons. Forward caries is said to be present wherever the caries cone in enamel is larger or at least the same size as that in dentin (see Fig. To differentiate between remineralizable and non-remineralizable dentin, staining carious dentin was proposed by Fusayama. Tooth Preparation: Amalgam versus Composite. The direction of the enamel rods, the thickness of enamel and dentin, the size and position of the pulp, the relationship of the tooth to its supporting tissues, and other factors all must be considered to facilitate appropriate tooth preparation. Comparison of acute and chronic caries regarding closeness, hardness, and depth factors of the softening, discoloration, and bacterial invasion fronts. Infected dentin has bacteria present, and collagen is irreversibly denatured. rotary cutting instruments. Line angles are distofacial (. Development of pain after endodontic intervention which is known as intra-appointment pain or flare-ups is one of the most common endodontic complications. The ability to isolate the operating area and the extent of the lesion or defect are factors that the operator must consider in presenting material options to the patient. Certain foods and drinks. This initial treatment plan, usually termed caries control treatment plan, may be followed by more definitive treatment once the patient’s risk for caries has been reduced. Learn vocabulary, terms, and more with flashcards, games, and other study tools. The direction of the enamel rods, the thickness of enamel and dentin, the size and position of the pulp, the relationship of the tooth to its supporting tissues, and other factors all must be considered to facilitate appropriate tooth preparation. hazards with cutting instruments. In the Journal of Periodontology, dental experts list nine risk factors for tooth loss due to periodontal disease.. Food is just not the only reason for tooth decay. Subtle differences in tooth development are very common–for instance roughly 10% of the population is missing some teeth. Of these, the terms backward caries and forward caries are rarely used. Much of this chapter presents information about the conventional tooth preparations because of the specificity required. progression may cause destruction of tooth structure which requires repair. Untreated tooth infections can spread to other areas of the body and lead to serious complications. Caries can be described according to location, extent, and rate.7. Primary caries is the original caries lesion of the tooth. It is imperative that the level of caries risk be assessed for all patients prior to the initiation of restorative treatment. A fissure (or pit) may be a trap for plaque and other oral elements that together can produce caries, unless the surface enamel of the fissure or pit walls is fluoride rich. These results can be used to guide future research in this area. In Figure 5-1, D, the cavosurface angle (cs) is determined by projecting the prepared wall in an imaginary line (w′) and the unprepared enamel surface in an imaginary line (us′) and noting the angle (cs′) opposite to the cavosurface angle (cs). There are many vital nutrients for the development of a healthy tooth, which includes Calcium, Phosphorus and Vitamins A, C and D. summary. Usually, remineralization is not possible, and treatment that includes tooth preparation and restoration is indicated. While tooth development can be influenced by environmental factors, genetics also plays a role in both the timing of tooth emergence as well as the number of teeth a person ends up with. The conservative restorative approach would be to crown these two teeth, and veneer the contralateral central and lateral incisor. Such caries is not acceptable if it is present at the DEJ or on the prepared enamel tooth wall (Fig. Lee W. Boushell, Theodore M. Roberson and Ricardo Walter. Likewise, an assessment of the occlusal relationships must be made. Affected dentin has no bacteria, and the collagen matrix is intact, is remineralizable, and should be preserved. The choice of restorative material affects the tooth preparation and is made by considering many factors. Nomenclature refers to a set of terms used in communication among individuals in the same profession, which enables them to understand one another better. 5-1, A). To solve the problem, the dental technician may be forced to angle the interproximal contacts to allow the restorations to be inserted, negatively affecting the esthetics of the case. Tooth location. It may be defined as the occurrence of pain and/or swelling following endodontic treatment appointment, requiring an unscheduled visit and active t… An arrested enamel lesion is brown-to-black in color and hard and as a result of fluoride may be more caries resistant than contiguous, unaffected enamel. In general, when designing preparations for restorations that are bonded (to enamel or dentin) versus cemented, cemented restorations require preparation that is more extensive. A tooth may require a restoration simply to restore form or function that is absent as a result of congenital malformation or improper position. Primary caries is the original caries lesion of the tooth. 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